Cases of co-occurring disorders have increased in the recent times, and are proving challenging to treat. This is due to the combination of symptoms that patients with these disorders exhibit. In order to effectively understand this disorder, it is important to analyze both the bi-polar disorder and substance abuse. Bi-polar disorder is a term which encompasses a variety of mood disorders which are otherwise known as hypomania if mild, and mania if more severe.
Most of the people who suffer from manic experiences also face depressive symptoms or episodes. Others have both depressive and manic episodes simultaneously, which can be referred to as mixed episodes. In most cases, there is an alternation between manic and depressive episodes, and they are separated by normal moods. However, there are also cases of rapid cycling where these moods alternate rapidly. In extreme cases of this disorder, hallucinations or delusions appear.
Substance abuse is a very common problem in the society today, and both men and women equally abuse drugs. The effects of these drugs vary to individuals depending on the body make up, intensity, frequency, type of drug and other factors. Hard drugs such as cocaine and heroin have been known to cause mental disorders such as hallucinations or delusions, in addition to harmful physical effects. These effects have also been known to appear after either withdrawing the normal dosage of these drugs or quitting them altogether. In light of these problems, it is necessary to seek medical help in order to treat these effects and restore the physical and emotional well being of the patients.
When patients exhibit both of these problems, that is bi-polar disorder and substance abuse, it becomes challenging to treat. This is because substance abuse causes the bi-polar disorder, and patients have to stop abusing drugs for the treatment intervention to work. One of the most effective forms of treatment which will be analyzed in the paper is the closed outpatient group therapy sessions. This form of treatment will be analyzed in more detail below;
There are two major forms of treating these disorders. These include group or other forms of therapy and the use of medication. The medication used in this case consists of antidepressants and other medication used to relieve the symptoms. On the other hand, the various therapy techniques are aimed at getting to the root of the problem and treating it. The closed outpatient group therapy is one of these forms of therapy, and it is aimed at instilling self esteem and helping the patients cope with the disorder, through sharing their experiences with other people with similar problems. It has become a very popular means of intervention due to its economy of scale and effectiveness. The paper will analyze this form of intervention with respect to women facing co-occurring disorders in more detail.
Closed outpatient group therapy.
As has been discussed, this form of intervention has gained popularity due to its effectiveness in treating the co-occurrence problem as well as the economy of scale. The economy of scale is achieved through treating patients in groups as opposed to as individuals and this is cheaper. It is effective due to the processes used such as peer confrontation, support and affiliation which enable patients to bond with a sense of recovery. The affiliation helps patient relate with other people with similar problems which helps to reduce problems such as depression, shame and isolation which accompany co-occurrence. As opposed to the in-patient group therapy sessions, the patient has relative freedom to interact with family and friends at the end of each treatment session. This provides support from the most intimate people the patient knows; his or her family. It is important to note that the only significantly major difference between the inpatient and outpatient therapy is that in the former, the patient is permanently in the treatment facility, while the latter enables the patient to recover at home after the sessions.
Benefits of this intervention method over others.
There are several advantages that group therapy has over other intervention methods, especially those which are individualistic in nature. Group therapy reduces isolation among patients and gives them positive peer support. The peer support involves feedback to patients from peers, who act as a family for the patients, which may even be healthier than the real family of the patient. The peer group also presents an opportunity for the peers to confront patients which reinforces discipline and structure, which is often absent in the lives of such patients (Weiner et. al., 2003). Confrontation from people facing a similar problem is very important since the patient is aware that they know what she is facing and they are not being unreasonable.
The fact that this is an outpatient therapy, the patient experiences support from his or her family on a regular basis. The patient recovers in an environment in which they are familiar with and this may speed up the recovery. In addition to this, the patient is exposed to the same situation which caused the problem, and self control under these circumstances help patients have little chances of relapse after recovery.
Criteria for outpatient group therapy.
Different individuals are suitable for certain types of groups, depending on the problems they face and their personality. Appropriate placement is very important especially considering the fact that recovery is a long process and once therapy is started, it is difficult to re-evaluate it. In placing a patient in a group, several factors are considered. These include the level of interpersonal functioning, stability, motivation to abstain from substance abuse, expectation of success and stage of recovery among others. Professional judgment is required in assessing these factors.
Most patients have the ability to function in heterogeneous groups which have mixed age, culture, gender and others (Alonso and Swiller, 2000). However, it is essential that patients with similar needs are matched. For instance, patients with extreme cases of bi-polar disorder need to be matched with those with similar problems. This is because they may not fit well with patients with lower levels of manic episodes. There are also patients who are unsuitable for group therapy. These include those who are reluctant to participate in therapy, those who do not honor agreements by groups, those who consistently violate the group regulations, those who make therapists uncomfortable, and those who are unable to control impulses amongst others.
The criteria for outpatient forms of therapy also depend on judgment from the health professionals. Individuals who have high chances of relapse, especially those who are addicted to hard drugs are unsuitable for outpatient therapy since they have low levels of self control. The patient’s family is also a factor to consider, and if they are not willing to support the patient’s recovery, in-patient therapy is recommended.
Group membership may either be fixed or variable depending on the circumstances. However, most of the groups are usually small with fixed members. Revolving membership occurs when members enter specific groups after they are ready for services offered in it. These groups may run for specific durations or indefinitely. Before patients are assigned to groups, they undergo pre-group interviews, and these are aimed at informing the patient on expectations, allaying anxiety and explaining the group agreement (Motherwell and Shay, 2005). Sensitivity is very important to people who differ from the current group due to age, gender, ethnicity and others. This is because that these people need reassurance that the difference may present vitality to the group rather than a deficit.
In order to prevent relapse especially in cases of substance abuse, it is very important to ensure that the patients are participatory and that there are adequate feedback channels to monitor the progress of individual patients. The outpatient therapy groups need more stringent monitoring and tests in order to detect any forms of relapse to patients. Group agreements are developed to establish expectations which members of the group have on the group itself, leader and each other. These agreements explain policies which include confidentiality, substance abuse, physical conduct, group participation, outside conduct, termination, financial responsibility among other issues. Acceptance of the contract is a major achievement toward successful group therapy of any patient.
Confidentiality and informed consent in therapy.
According to the American Group Therapy Association, which regulates the conduct of group therapists, the mental health counselors should provide knowledge on the therapy they give to clients, in a manner which enables them to make an informed decision or choice (Field et. al., 2007). The agreement which the therapists and clients enter into is founded on mutual consent or agreement and trust. The health care professional should provide full information on relevant issues which include obligations and rules of therapy, scheduling fees and others, in a humane and tactful manner which provides realistic expectations to the patient. The same principles are applied to minors though their stage of development and age will determine how these will be applied.
Regarding confidentiality, the American Psychiatric Association which regulates the conduct of mental health care professionals, states that these professionals have the duty to keep all discussions held confidential, unless consent is given to discuss it with third parties. The consent should be in writing and should come from the patient or legal authority such as court of law. There should be a court order in writing before such confidentiality can be breached. The health care professional cannot rely on the consent of the patient in case he or she judges the patient to be mentally unstable. Finally, the psychiatrist has the duty to keep all materials, recordings or discussions relating to the session in a place where they are reasonably secure or safe.
Goals and expectations of the outpatient group therapy sessions.
The major goal and expectation of this treatment intervention is to treat the disorder that the patient has (Hay et. al., 2002). In case the patient also faces substance abuse, the therapy session is expected to eliminate the dependence on drugs. The therapy sessions go further and build self esteem such that the patient is confident in his or her ability to stay off drugs and achieve their goals in life. Therapy sessions are also aimed at ensuring that the patients who have recovered can fit in the community and live in harmony. Finally, the patients who have fully recovered sometimes benefit from employment or other opportunities which help them to be independent, from the psychiatric facility.
Summary and conclusion.
Outpatient group therapy is a very common form of intervention for patients who face co-occurring disorders, and this has been seen to be due to its effectiveness and economy of scale. It is a very effective treatment intervention due to the fact that peers with similar problems are treated together. After the sessions, the patient is given an opportunity to recuperate in an environment in which he or she is familiar with, and with the support of their family. It is very important for the therapists to match the needs of the patients before placing them in a group. This is due to the reason that it is a long term treatment technique and that it is important for all members to be comfortable for it to work effectively. It is also important to analyze the decision to provide outpatient therapy carefully in order to minimize chances of relapse. Finally, the family and community should support the patient in order to for him or her to recover effectively.
Alonso, A., Swiller, H. I. (2000). Group Therapy in Clinical Practice. New York: American Psychiatric Pub.
Field, M. J., Jette, A. M., Institute of Medicine (U.S.). Committee on Disability in America. (2007). The Future of Disability in America. Washington: National Academies Press.
Hay, W. W., Hayward, A., Levin, M. J., Sondheimer, J. M. (2002). Current Pediatric Diagnosis & Treatment. Washington: McGraw-Hill Professional.
Motherwell, L., Shay, J. J. (2005). Complex Dilemmas in Group Therapy: Pathways to Resolution. London: Routledge.
Weiner, I. B., Freedheim, D. K., Nezu, A. M., Schinka, J. A., Nezu, C. M., Velicer, W. F., Geller, P. A. (2003). Handbook of Psychology: Health Psychology. New York: Wiley and Sons.