Friday, September 7, 2012


Part of my job is facilitating groups in partial hospital and intensive outpatient programs. In these more acute, intensive but time-limited treatment settings, there is almost continuous client turnover, with clients admitting and discharging almost daily. The population as a whole remains at about the same point in the change process, because once people stabilize, they discharge to a lower level of care. 

As a result, group content also has to repeat quite frequently: at admission, the majority of clients are in crisis and lacking the skills, knowledge, insight and/or motivation to manage it. If we (staff) don't continue to review foundation skills, newer clients don't have that foundation. 

However, although length of stay is relatively short, there is a great deal of variability. PHP averages 2-4 weeks, but may be shorter or longer. IOP can be anywhere from 2 to 6 weeks, or longer. If someone does both programs, they might be with us anywhere from 2 to 10+ weeks. Added to that, some clients repeat the program, sometimes after a period of time in inpatient or residential treatment, sometimes after a period of time in standard outpatient (or even no) treatment. 

This poses a problem/dilemma for staff: provide foundation skills and information needed by new clients (even though people who have been with us a long time, or repeatedly, have already heard it), or try to find group material that no one present has previously encountered. I have typically taken the latter approach: feeling bad for "old-timers" who may be bored, I rack my brain and scour my files for new ideas and activities I haven't used in the last 2 months (or longer). 

However, I've come to think that repeating a topic or activity may not be such a bad thing after all. Sure, some clients take one look at a handout, and roll their eyes because they've "done it already." But this is only partially true: the constellation of the information/activity with the client's current point in treatment and recovery is new. Hearing information again after you've had a few additional weeks of intensive treatment, with all of its ups and downs, means that you're hearing it in a different way, applying it in a different way, and (hopefully) integrating in a new or more complete way. It's been a particularly powerful experience - for clients, and me - to witness new breakthroughs from this kind of repeat material. 

Maybe I can stop worrying so much about repetition, and embrace it as another part of the process!

No comments:

Post a Comment