To evaluate the effect of compulsory community treatment orders on subsequent time out of the hospital, the authors studied the admission dates of psychotic patients who had repeated hospitalizations in Quebec, Canada, and divided each admission according to its time in relation to the index admission, during which the judicial order was obtained. The data were stratified by type of admission (early, preindex, index, or postindex), and the hypothesis tested was that the median time to readmission would be greatest for the index admission. The hypothesis was confirmed, supporting previous findings that judicial orders that mandate severely ill psychotic patients to undergo compulsory community treatment are associated with decreased time spent in the hospital and thus increased personal freedom.
The benefits of a long-term weekly therapy group for individuals suffering with schizophrenia have been evaluated. The data were derived prospectively from 308 sessions over 7 years in an outpatient hospital setting. Results show trends in the individual members to engage in more emotionally meaningful interactions in the group. The group has served not only as a container for the depression, anxiety, and psychosis of its members but also for the development of their humor, support, and insight. Although there was no control for variables other than group participation, the data suggest that each member, given enough time and support can increase his or her own level of maturation and functioning in a group setting.
This paper describes a pivotal group session in which there was a major conflict between two members of a group that has met for many years. The group serves chronically ill outpatients suffering primarily from schizophrenia or schizoaffective illness. The aftershocks of the explosive outburst, the leaders' understanding of the contributing factors, countertransference feelings, and coping mechanisms are described. The literature recommends two pathways concerning the expression of anger and aggression in groups of severely disturbed individuals: restriction of intense negative affect or expression of such affect as a helpful component of a therapeutic process. We reflect on this question in sharing detailed clinical material and conclude that coping with aggression in such groups is dependent not only on the group context, but also on the relative fragility, strength, and tolerance of both members and leaders. A crucial step in dealing with eruptive crises consists of reflecting upon the leaders conscious and unconscious intervention motives and affects.
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