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 Table of Contents  
BRIEF COMMUNICATION
Year : 2020  |  Volume : 36  |  Issue : 4  |  Page : 359-362

Group meeting in psychiatric inpatient setting: Psychological intervention and outcome difference across gender


Department of Clinical Psychology, Amity University, Kolkata, West Bengal, India

Date of Submission18-Apr-2020
Date of Decision19-May-2020
Date of Acceptance19-Jun-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Susmita Halder
Department of Clinical Psychology, Amity University, Major Arterial Road (South.East), Action Area II, Newtown, Kolkata - 700 135, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_75_20

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  Abstract 


Being part of a group is likely to increase the affiliation of the members, serving as a source of support in times of crises and distress. Group meetings are part of the therapeutic action provided to a group of individuals, together in their inpatient setup. This enables in developing a rapport with the unit as a whole and resolve any misunderstanding or discrepant information, as far as possible. The present study aims to explore the efficacy of group meetings in a psychiatric inpatient setting in males and females in terms of the process and outcome. In the present study, the total sample consisted of twenty inpatients at a mental health-care unit, of which 9 were females and 11 were males. These two groups consisted of individuals with mixed diagnosis. Group meetings along with individual therapy for each of the patients were conducted separately for both the groups over a span of 15 sessions. Results of the study showed that the group meeting was found to be effective as was reflected in terms of the outcome measures. Further, sex-related differences were found to be present across several measures. Thus, the present study further highlights the importance of group meetings as an adjunct to ongoing intervention in psychiatric inpatient wards and also warrants a customization in the plan and approach for males and females separately.

Keywords: Females, group meeting, inpatient, males


How to cite this article:
Manot S, Halder S. Group meeting in psychiatric inpatient setting: Psychological intervention and outcome difference across gender. Indian J Soc Psychiatry 2020;36:359-62

How to cite this URL:
Manot S, Halder S. Group meeting in psychiatric inpatient setting: Psychological intervention and outcome difference across gender. Indian J Soc Psychiatry [serial online] 2020 [cited 2021 Jan 16];36:359-62. Available from: https://www.indjsp.org/text.asp?2020/36/4/359/305955




  Introduction Top


Patients admitted in inpatient wards experience much more than the disorder and care they receive. Their admission into psychiatric settings brings with it uncertainty regarding the reason of admission as well an addition task of adjusting to the new environment, where other individuals have already been residing. With respect to patients admitted in wards, it has been seen that hospitalized patients generally have more severe illnesses.[1] Psychosocial interventions become imperative in such situations to ensure a balance between treatment and adequate quality of life. Inpatient group intervention is part of the standard treatment in many psychiatric wards worldwide.[2] Being part of a group is likely to increase the affiliation of the members, serving as a source of support in times of crises and distress. Group meetings are part of the therapeutic action provided to a group of individuals, together in their inpatient setup. This enables in developing a rapport with the unit as a whole and resolve any misunderstanding or discrepant information, as far as possible. Further it enables in exploring individual as well as group skills of the inmates and put them to constructive use. Group meetings further facilitate in getting knowledge and a better understanding of their illness condition as well as that of others and learn better ways of coping.

Inpatients in psychiatric wards can include individuals from any sex, age, race, education, and socioeconomic background. Although these sociodemographic variables can each have a significant impact on the process and outcome of group meetings, in the present study, the focus will be on the sex differences. It has been seen in a study[3] that women reported generally less positive experiences than men on specific aspects of their setting. Male and female patients behave differently when they present with the same objective symptoms and that health-care professionals behave differently toward male and female patients based on different assumptions regarding gender.[4] Very few studies have investigated the group meeting efficacy with respect to sex differences; thus, the present study aims to explore the efficacy of group meetings in a psychiatric inpatient setting in males and females in terms of the process and outcome.


  Subjects and Methods Top


In the present study, the total sample consisted of twenty inpatients at a mental health-care unit, of which 9 were females and 11 were males. The age range for the female group was 14–66 years and that for males was 21–73 years old. The study was conducted for a duration of 1 month. During the study, one male patient was discharged from the center, thereby reducing the number of male patients to 10 for the last two sessions. These two groups consisted of individuals with mixed diagnosis, the most common being bipolar affective disorder (BPAD), psychosis, and depression. The patients were included in the groups based on their ability to comprehend verbal instructions and respond adequately and an absence of any physical restraint.

Group meetings along with individual therapy for each of the patients were conducted separately for both the groups over a span of 15 sessions for each group, every week for 30 min each. The sessions would begin with group meetings and then proceed to the individual therapy. The group meeting sessions were structured and preplanned to include the following:

  • Enhancing insight and awareness
  • Increasing social skills and social interaction
  • Increasing involvement in work
  • Improving coping
  • Recreational activities.


Procedure

The study was conducted after approval from the research and ethics committee. Participants in the two wards of the psychiatric setting were briefed about the group meetings and were asked to participate with their consent, and those who were not willing were not included in the study. All the nine female inpatients agreed to participate, while of the 14 male inpatients, 11 participated. The group meeting time was fixed for each week and would happen at the same time for each of the groups. Trained clinical psychologist would conduct the sessions every week in a structured manner. The Insight and Treatment Attitudes Questionnaire and the Psychological General Well-Being Index were administered to all the participants as baseline measures. The meeting would begin with greeting the group as a whole, followed by taking an attendance. Then, the structured plan would be followed beginning with psycho-education about several relevant topics, followed by enhancing their social skills using self-reflection methods as well as by interactions within the group. This would be followed by focusing on individual skills and interest areas, as well as their applicability in group tasks; then they would be given everyday life problems to solve and come up with solutions or alternative ways of coping to increase their coping. Finally, the session would end with some recreational tasks such as singing or playing word games. In between the sessions, any problem that would arise would be handled by communicating with the patients and resolving it as much as possible. At the end of the last sessions, the two tools previously used were administered again to see postintervention changes. Finally, the outcome of the sessions was assessed to evaluate the impact the group meeting had, using both qualitative and quantitative measures, in terms of:

  • Clinical observation of behavior
  • Performance on pre- and post-tests.
  • Insight
  • Subjective Psychological well-being.



  Results Top


[Table 1] shows that it can been seen that majority of the male inpatients were diagnosed with schizophrenia or depression, while for females, the majority of them were diagnosed with schizophrenia and BPAD. The other diagnosis for females included borderline personality disorder, while for males, it was dementia, intellectual disability, and delusional disorder. In spite of the varied diagnosis, some of which are not always considered suitable for group sessions, all of them were cooperative, complied in the sessions, and participated as much as the other individuals.
Table 1: The clinical details of the sample

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  Discussion Top


The present study was carried out with the objective of exploring the efficacy of group meetings in a psychiatric inpatient setting in males and females in terms of the process and outcome. From [Table 2] it can be seen that there was a significant improvement post the group meeting as reflected in terms of improved insight and subjective psychological well being highlighting the efficacy of the same. Improvements were also seen in terms of qualitative measures such as the overall participation, initiation of response, comfort in conversation, and following rules.
Table 2: The pre-post quantitative and qualitative measures across the group

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Overall, a change was seen in the process of conducting the meetings, as there was better rapport over the sessions resulting in smooth interactions and discussions. Further, there was increased participation from patients who would refuse to respond due to either rigidity or shyness. They would participate even without being persuaded at times. Although it cannot be said with certainty that just after group meeting sessions, there was a complete change in patients, significant changes were quite observable. Even in the way of communication, the posture, the ease of speech, and decreasing inhibition were evident as the sessions progressed. The psychoeducation was effective in clearing their misunderstandings and enhancing their insight to a considerable extent, and this is in line with a previous study that showed improved insight and psychological well-being in hospitalized inpatients' postgroup meetings.[5] Overall, both the groups showed changes post the group meeting which would often reflect in the individual sessions taken by the same therapist, these changes were mainly in terms of improved self-perception, better rapport with other members in the group, and increased tendency to voice their thoughts.

Further, it was seen that overall greater resistance to the meeting was present in the male group as a whole, when compared to females, especially in terms of initiation of responses and accepting the benefit of the group meeting. The more aged male participants would show resistance at times and would question the purpose of the group meeting also. This could reflect the impact of being hospitalized for so long, thereby resulting in a sense of hopelessness as well as the general impact of aging, wherein thinking tends to become rigid and less open. This has been seen earlier in a study, wherein thought rigidity was found to be curvilineal related to age, more in men than women, and that patients with schizophrenia are more rigid.[6] This also reflects the inherent point that men are less inclined than women to seek help for psychological issues.[7] By the end, however, they had all become more prompt in responding. Even the participants who would not respond at all in the first two sessions started responding comparatively more in the subsequent sessions. It has been seen that males reported higher levels of horizontal cohesion, wherein they showed greater bonds of confidence as a single unit, and similarly, from [Table 3] it can be seen that in the present study there was greater group feeling in the males, as evidenced in less interruption of each other and greater discussion before responding.[8]
Table 3: The qualitative measures of group meeting across the group

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Within the females, greater disclosure of group information was found to be present, as was evident in a few sessions, wherein the patients would reveal information about the happenings in the ward and their distress related to it. This reflects the greater help-seeking behavior that is present in females when compared to males.[9] It seemed as if they had found an outlet to express their grievances in the meetings. This further highlights that although men and women may equally benefit from emotional sharing, they might have different starting points in therapy.[10] In the females patients, another very common occurrence was that of participants interrupting each other, and it had reduced by the last session to a great extent. They showed greater enthusiasm in participation and would ask more questions during the sessions. Even in the female ward, few patients would be reluctant to respond due to evident shyness, and with encouragement and persuasion over the sessions by the therapists, there was a slight improvement in their participation. These were patients mostly falling in mood spectrum disorders and thereby explaining their reduced participation to some extent.

Thus, the findings of this study indicate the efficacy of group meetings as an adjunct psychosocial intervention for psychiatric inpatients and also move a focus toward the importance of taking the gender of clients into account to plan and structure the group interventions to improve the success of their practice, its outcomes for the clients as well as to reduce the likelihood of clients dropping out prematurely.[11] The results of the study tend to be considerably measurable and highlight that, irrespective of gender differences, group meetings tend to facilitate the enhancement of insight and increasing awareness among individuals more fluidly and promptly as compared to the individual sessions. The inculcation of knowledge tends to be better when other individuals are also supporting or explaining something as a group.

Although the aim of the present study was to explore the efficacy of group meeting in a heterogeneous group, wherein all individual required and were suitable for intervention, the impact of the group meeting may not have been the same for all. Furthermore, outcome measures were mostly established in terms of qualitative findings; although quantitative measures were obtained, they could not be specified in terms of core symptom change. Further, the generalizability of these findings is difficult for any specific diagnostic groups, even though group meetings were found to be effective in the present study.

This points toward the need of more studies to establish the efficacy of group meetings in homogeneous groups, using more specific quantitative measures. In spite of the effectiveness of group meetings and the relative ease of its application, there tends to be a limited number of studies exploring the efficacy of group meetings, especially in the Indian context, thereby warranting more such studies.


  Conclusions Top


This study has shown that group meetings tend to have positive outcomes for patients who have been admitted in psychiatric settings. Further it was seen that men and women differ in important ways with regard to their involvement and preference for therapy, the meaning they make of it and the help seeking behaviors they demonstrate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kösters M, Burlingame GM, Nachtigall C, Strauss B. A meta-analytic review of the effectiveness of inpatient group psychotherapy. Group Dynamics Theory Res Pract 2006;10:146.  Back to cited text no. 1
    
2.
Farley PN. Current Practices in General Hospital Group Psychotherapy. (Doctoral Dissertation, Virginia Tech); 1998.  Back to cited text no. 2
    
3.
Elliott MN, Lehrman WG, Beckett MK, Goldstein E, Hambarsoomian K, Giordano LA. Gender differences in patients' perceptions of inpatient care. Health Serv Res 2012;47:1482-501.  Back to cited text no. 3
    
4.
Safran DG, Rogers WH, Tarlov AR, McHorney CA, Ware JE Jr. Gender differences in medical treatment: The case of physician-prescribed activity restrictions. Soc Sci Med 1997;45:711-22.  Back to cited text no. 4
    
5.
Halder S, Mahato A, Choudhury S. Efficacy of group meeting on hospitalized patients. Ind Psychiatry J 2007;16:40-1.  Back to cited text no. 5
    
6.
Schultz PW, Searleman A. Rigidity of thought and behavior: 100 years of research. Genet Soc Gen Psychol Monogr 2002;128:165-207.  Back to cited text no. 6
    
7.
Ross CE, Bird CE. Sex stratification and health lifestyle: Consequences for men's and women's perceived health. J Health Soc Behav 1994;35:161-78.  Back to cited text no. 7
    
8.
Rosen LN, Bliese PD, Wright KA, Gifford RK. Gender composition and group cohesion in US army units: A comparison across five studies. Armed Forces Soc 1999;25:365-86.  Back to cited text no. 8
    
9.
Kessler RC, Brown RL, Broman CL. Sex differences in psychiatric help-seeking: Evidence from four large-scale surveys. J Health Soc Behav 1981;22:49-64.  Back to cited text no. 9
    
10.
Liddon L, Kingerlee R, Barry JA. Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking. Br J Clin Psychol 2018;57:42-58.  Back to cited text no. 10
    
11.
Swift JK, Callahan JL, Vollmer BM. Preferences. J Clin Psychol 2011;67:155-65.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Subjects and Methods
Results
Discussion
Conclusions
References
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