Home Health Casebook of Interpersonal Psychotherapy
An important aspect of ending the group is encouraging members to discuss the progress they have made and the changes they have witnessed in one another. Crediting each member for changes each has made is important, because members may tend to attribute these changes to therapists, outside circumstances, or the efforts of others. Such misplaced credit could erode members’ confidence in their continued success and improvement without further treatment. A review of progress should increase members’ self-confidence and awareness of new interpersonal skills. Therapists should encourage group members to recognize the importance of assuming responsibility for monitoring their own lives, their relationships, and their involvement in social activities.
Maintaining Therapeutic Gains
The therapist should direct each member to identify areas that require further attention, as not all goals may have been achieved within the group’s time frame. To anticipate future difficulties, the therapist cultivates discussion of preparing for and addressing these challenges should they arise. By discussing these issues openly, group members will grow to understand that continued change and progress require effort comparable to the work they have already been doing. Predicting that setbacks will occur helps members to be realistic about change, and underlines that continued benefits necessitate personal responsibility for applying strategies developed during IPT-G. This important theme counters passivity and undue reliance on others.
Guiding members in a discussion of contingencies for handling future problems will bolster feelings of competence. It is vital to assist members in thinking about warning signs and symptoms that suggest need for future treatment. The therapist may recommend that members discuss potential warning symptoms with significant others, as such indicators can help members and others in their social environment to notice changes much as in the group. Therapists can encourage members to write down and to rehearse strategies to handle such warning signs.
For group members who have not responded to group treatment and continue to experience distress, the therapist should recommend continued psychotherapeutic treatment, perhaps in individual format, and provide relevant referral information. The therapist may determine that pharmacotherapy is warranted for some members upon termination, and should provide referrals for such follow-up accordingly.
Four to six months after termination, an individual follow-up visit with each former member allows an assessment of level of functioning and gains or setbacks following group termination. It serves as an incentive for the patient to continue working towards individual goals established during IPT-G. Members who have relapsed may need arrangements for additional treatment at this time.
In summary, termination is a transition marking the end of one format for change and movement toward the beginning of another. Members must become their own “therapists” following their experience in group treatment.
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