‘Most Important Events’ and Therapeutic Factors: An Evaluation of Inpatient Groups for People with Severe and Enduring Mental Health Difficulties

Abstract

People with severe and enduring mental health difficulties attending groups on 10 inpatient wards were asked to identify the ‘Most Important Event’ (MIE) in each group session they attended, as part of a routine service evaluation. Using the methods of thematic analysis, five main themes were identified from the 192 Most Important Events recorded over the course of one year: Being part of a group, Communication, Help and support, Hope for the future, and Relationships. The main themes and subthemes were largely compatible with Yalom’s therapeutic factors, but also suggested that more fundamental levels of therapeutic factors may be present in groups with people with severe and enduring mental health difficulties. These factors include feeling connected, communication, and a sense of belonging. This evaluation of Most Important Events in inpatient groups adds to the evidence base in the field of group analysis and group psychotherapy.

Keywords

Most Important Events (MIEs)therapeutic factors inpatient group therapy severe and enduring mental health difficulties thematic analysis

Introduction

Is group psychotherapy helpful in treating people with severe and enduring mental health difficulties? Fontao and Hoffman (2011) argued that research during the last five to six decades has not been conclusive. In contrast, Gonzales de Chavez, Gutierrez, Ducaju and Fraile (2000) asserted that group psychotherapy in combination with anti-psychotic treatment has been shown to be effective in the treatment of those diagnosed with schizophrenia. Overall, the consensus has been that further research is needed.

Group psychotherapy has been evaluated using a variety of methodological approaches, including the exploration of therapeutic factors (e.g. Corsini and Rosenberg, 1955; Bloch and Crouch, 1985; Yalom, 1985; Restek-Petrovic, Bogovic, Oreskovic-Krezler, Grah, Mihanovic and Ivezic, 2014). The concept of therapeutic factors was initially devised by Yalom (1970) to provide an understanding of clients’ perceptions of the effectiveness of group psychotherapy. Yalom defined ‘curative factors’ as ‘mechanisms of change (that occur) through an intrinsic interplay of varied guided human experiences’ (Yalom, 1985: 3). His 11 therapeutic factors are now widely accepted as representing the basic mechanisms of therapeutic change in group therapy and are regarded as fundamental to the dynamics of groups (Gonzales de Chavez et al., 2000).

Yalom’s (1970) research explored therapeutic factors, group processes and functioning in a wide range of therapeutic settings. Studies using his therapeutic factors measure in outpatient psychotherapy groups consistently found that interpersonal learning, catharsis, group cohesiveness and self-understanding were most valued by group members (MacKenzie, 1987). However, in inpatient mental health wards, altruism and hope were ranked higher (Maxmen, 1973). More recently, Restek-Petrovic et al., (2014) found that instillation of hope, group cohesiveness and existential factors were ranked as most important in their study of 57 psychiatric outpatients.

The ‘Most Important Event’

Therapeutic factors have themselves been studied in a variety of ways, including through group members’ self-reported subjective experiences. Yalom (1985) studied therapeutic factors through the events identified by group members as being the most important in the group session. Interaction between group members was one of the main therapeutic mechanisms identified. More recently, Yalom reported that he routinely inquired about ‘. . . some critical incident, a turning point, or the most helpful single event in therapy’ (Yalom and Leszcz, 2005: 28).

Similarly, MacKenzie (1987) reviewed the use of patient-reported ‘critical incidents’ to identify important events within group sessions. His review included consideration of the Most Important Event Questionnaire (MIEQ) devised by Bloch, Reibstein, Crouch, Holroyd and Themen (1979). These authors reported their use of the MIEQ at three-weekly intervals in evaluating their long-term outpatient groups. The MIEQ has since been used in a number of studies and for a variety of purposes. For example, Kennard, Elliot, Roberts and Evans (2002) used an adapted version of the MIEQ at the end of each of 12 days of group analytic training conducted through a language interpreter in St Petersburg, to evaluate the effectiveness of that mode of training.

Bledin and Waters (2004) described a small-scale service evaluation of group-based psychosocial interventions in an inpatient mental health rehabilitation ward for people with severe and enduring mental health difficulties. They used the MIEQ at the end of each group session in a series of short-term structured psycho-educational groups conducted in the ward. When MIEQ responses were mapped on to Bloch et al.’s (1979) therapeutic factors, they indicated that group members seemed most frequently to value acceptance, self-understanding and guidance.

Problems with Measuring Outcome in Inpatient Groups: The Case for a Qualitative Methodology

Groups in inpatient settings commonly include patients with a range of diagnoses, symptoms, and behaviour and cognitive profiles. They therefore need to be broad and flexible, even when a specific group task is identified (see Scaturo, 2004). Inpatient groups may be open to all patients who can access the group, rather than being managed by a referral and assessment process (e.g. see Yalom, 1983). It is also likely that inpatient groups may be heterogeneous in terms of group members’ reasons for attending. Group membership in inpatient settings is often variable, with some people attending a group only once, others coming regularly, and some attending sporadically over a period of time. People admitted to inpatient wards are usually undergoing acute crises or significant change in their mental state. This may make it difficult for them to complete standardized self-report measures relating, for example, to their experience of group participation. Taking all these factors into account, it follows that qualitative research methods may be more effective than standardized quantitative measures in capturing group members’ experiences.

In addition, many inpatient groups, notwithstanding their narrowly defined tasks, may have several intended outcomes and agendas. For example, a ‘thinking well’ group may aim to: facilitate structured experiences of logical and rational thinking; facilitate learning by group members about logical and disordered thinking; encourage more reality-checking in group and daily life; facilitate communication, reciprocity and opportunities for mirroring between group members; offer opportunities for translation and interpretation by the therapist. This range of outcomes may be difficult to capture using standardized and/or quantitative measures and may be evaluated more comprehensively using qualitative methodologies.

A qualitative approach such as the Most Important Event Questionnaire (MIEQ; Bloch et al., 1979), which is non-intrusive, acceptable to participants and which supplies relevant clinical information, may provide the most satisfactory means to the systematic and comprehensive collection of group data (MacKenzie, 1987).

The MIEQ was employed in this evaluation of groups conducted in inpatient wards in a large inner-city NHS Trust in central London.

Method

Groups conducted on eight acute admission wards (with typical length of stay of 1–3 months) and two rehabilitation wards (typical length of stay 9–12 months) of an inner-city Mental Health Trust in London were included in this service evaluation. The evaluation included only talking (as opposed to activity-based) groups facilitated or co-facilitated by clinical psychologists. Group duration ranged from one-off sessions to open-ended, and had a range of therapeutic goals, including psychoeducational, skill acquisition or supportive. The evaluation period covered 12 months, from 1st March 2010 to 28th February 2011. Table 1 describes each of the treatment groups included in the evaluation.

Table 1.

Therapy groups included in the evaluation.

Group Name	Group Format	Nature and Purpose of Group	Ward Type
Getting Well, Staying Well	Open-ended, weekly	Supportive, skill acquisition	Acute admission^a
Feeling Good Group	6 sessions, weekly	Skill acquisition	Acute admission^a
Mindfulness Skills Group	6 sessions, weekly	Skill acquisition	Rehabilitation
Lifeskills / Living Well	8 sessions, weekly	Psychoeducation	Rehabilitation
Thinking Well Group	2 x 8 sessions, weekly	Supportive, skill acquisition	Rehabilitation
Mutual Support Group	Open-ended, weekly	Supportive, skill acquisition	Acute admission (two wards)^b
Leaving Hospital Group	Open-ended, weekly	Supportive, skill acquisition	Acute admission (five wards)^b
Tree of Life^c	7 x single-session	Narrative therapy/ supportive	Acute admission (five wards)^b

Women-only ward.

Each group session was open to patients from all these wards.

Ncube, 2006.

Group Members

The groups described in this evaluation included residents of wards for adults (most aged 18–65, a small minority over the age of 65) with severe and often chronic mental health difficulties, usually with diagnoses of schizophrenia and other psychoses, bipolar affective disorder and personality disorders. Co-morbidity and substance misuse are common in this population, as are cognitive deficits associated with severe and enduring mental health difficulties and long-term use of antipsychotic medication, particularly among those with histories of frequent or repeated admissions.

Exclusion Criteria

Most patients present on the wards at the time of scheduled groups were invited or reminded by ward staff to attend the groups. Patients were excluded if they were considered to be acutely distressed at the time of the group, too disruptive to the safety of the group as a whole, too disturbed to be able to respect the ‘group rules’ and boundaries, or if their command of English was too limited to allow them to participate meaningfully in group sessions.

Procedure

The purpose, style and therapeutic intentions of the groups varied, but a standardized evaluation procedure was used. The group facilitators asked each patient at the end of each group session a simplified version of Bloch et al.’s (1979) Most Important Event Questionnaire: ‘What was the most important event for you in today’s group meeting?’ Group members’ verbal responses to this question—their Most Important Events, or MIEs—were written verbatim on flipcharts for all group members to view. They were later transcribed for subsequent analysis, as part of a routine service evaluation.

Analysis of Most Important Events (MIEs)

The MIEs were examined using thematic analysis (Braun and Clarke, 2006). This qualitative method of analysis was considered appropriate for the present evaluation as it provides ‘. . . a method for identifying . . . and reporting patterns (themes) within data’ (Braun and Clarke, 2006: 79). The authors familiarised themselves with the coding procedure described by Braun and Clarke (2006) by coding a smaller sample of data gathered from groups conducted in the same wards, but which pre-dated the evaluation period and were therefore not included in the present analysis.

The MIEs gathered during the 12 months of the evaluation period were then evaluated by the authors, through a process of group discussion and negotiation, following and repeatedly referring to Braun and Clarke’s (2006) thematic analysis methodology to identify main themes and subthemes. The prevalence of these main themes and subthemes are presented quantitatively in the following sections. This is consistent with Braun and Clarke’s (2006) encouragement of flexibility in data analysis, and highlights that empirical evaluations of this kind are rare in the published literature.

Results¹

Data were gathered from 11 time-limited groups and three open-ended weekly groups. Group members were patients from eight acute admission wards and two rehabilitation wards. Individual attendance at these groups and group size were not consistent over time. Average group size was 3–4 across all the groups, an attendance rate that is typical of groups in inpatient settings such as these. The full data set comprised 192 Most Important Events (MIEs) recorded in the 15 groups listed in Table 1. The MIEs were collated into 52 initial codes and subsequently into six potential themes. The potential themes were reviewed repeatedly by the authors in a further series of group discussions before five main themes and 14 subthemes were defined and named (Table 2).

Table 2.

Main themes, subthemes and codes.

Main Themes	Subthemes	Examples of Codes
1. Being Part of a Group	Structural Factors	Engaging in group task
	Cognitive Aspects	Thinking (about self and others)
	Togetherness	Group membership/participation
	Peace of Mind	Feeling calmer
2. Communication	Self Expression	Opportunities to express oneself
	Exchanging Information	Talking with others
	Learning	Learning and remembering
3. Help and Support	Receiving Help and Support	Practical help and advice
	Emotional Support	Empathy, feeling accepted and safe
	Practical Issues	Employment, education, housing and physical health
4. Hope for the Future	Hope	Hope and optimism
	Future	Preparing for discharge
	Future	Planning for future
5. Relationships	Self in Relation to Others	Feeling understood
5. Relationships	Family and Friends	Friendship

1. Being Part of a Group

The first and largest main theme identified was Being Part of a Group. Ninety six responses referred to some specific aspect of being part of the groups as the most important, or one of the most important events. A prevalent subtheme of this main theme was Structural Factors relating to the group (38 MIEs); in particular, engaging in the Group Task (34 MIEs) was the most important event for group members. A second subtheme was Cognitive Aspects of the Group (23 MIEs), which included the codes Thinking about Self and Others (six MIEs) and, more simply, Thinking (five MIEs). Two further subthemes which contributed significantly towards this main theme were Togetherness in Group (14 MIEs) and Peace of Mind (12 MIEs).

I felt together with other people . . . we had something to do together . . . we all joined in . . . feel part of something . . . like a team.

2. Communication

Communication was the second largest main theme (49 MIEs) identified in the data. Subthemes under this main theme included Self-expression (13 MIEs), Exchanging Information (13 MIEs) and Learning (11 MIEs). Examples of codes included in these subthemes were, respectively, Opportunities to express oneself, Talking with others and Learning and remembering (what was said in the group).

It’s helpful to discuss difficult things . . . to give my opinion . . . to hear everyone else’s opinions . . . to be listened to and understood.

3. Help and Support

This theme comprised 29 MIEs, most commonly within the subtheme Receiving Help and Support (13 MIEs). This subtheme included references to practical help and advice, while a second subtheme, Emotional Support (eight MIEs), comprised important events alluding to the experience of empathy, feeling accepted and feeling safe in groups. A third subtheme, Practical Issues (seven MIEs), included specific social issues with which group members felt helped or supported in their groups, such as employment, education, housing or physical health.

Group helped me to find out that help and support are available . . . helped me to accept help from others.

4. Hope for the Future

This theme comprised 12 MIEs in two subthemes, Hope (MIEs referring to Hope and Optimism or Feeling Inspired (eight MIEs); and Future: preparing for discharge, and planning for the future (four MIEs).

I feel encouraged that I might find work when I leave hospital . . . I might be able to do things to feel proud of myself.

5. Relationships

Twelve MIE responses were coded into subthemes labelled Self in Relation to Others (nine MIEs) and Family and Friends (three MIEs). MIEs coded together as Feeling understood in the group dominated the first of these subthemes (five MIEs).

People try to understand each other . . . people don’t judge me . . . we try to get to know how we feel about each other.

Discussion

Shortly before his recent death, James Anthony asserted that empirical research in group analysis is ‘critically important for the future’ (Anthony, 2016: xxvii). This article adds to the growing evidence base in this field.

Several of the main themes and subthemes identified in the results section above were compatible with one or more of Yalom and Leszcz’s (2005) therapeutic factors; these are elucidated in the following discussion. This finding suggests that group members unwittingly recognized therapeutic factors inherent in their groups and reported them as Most Important Events. These MIEs were often expressed less articulately or in less psychologically sophisticated terms than in Yalom’s reports (e.g. Yalom, 1985). This may be explained by the differences between the groups in Yalom’s early research (e.g. see Yalom and Leszcz, 2005) and those considered here. Yalom’s research was with relatively high functioning groups while the groups included in the present evaluation comprised inpatients with long histories of severe and enduring mental health difficulties, often with associated cognitive and social impairments.

The majority of group members in the present evaluation described structural factors relating to their therapy groups, and the specific task of their groups, as the Most Important Events in their groups. This finding reflects the fact that several of the groups included in this evaluation were predominantly task-oriented, skills-acquisition groups. The subthemes within the Being Part of a Group main theme included Togetherness in Group and Peace of Mind. These evoke, respectively, Yalom and Leszcz’s (2005) Group Cohesiveness and Existential therapeutic factors; they indicate the importance to group members of the psychotherapeutic value of the groups—despite their being primarily psychoeducational or skills-based in purpose and structure. Similarly, Thinking about Self and Others (cf. therapeutic factors Altruism and Development of Socialising Techniques) was an important element in the third subtheme Cognitive Aspects of the Group. These findings together support the assertion that through resonance and reciprocity, psychological benefits may emerge in therapeutic groups (Schlapobersky, 2016).

The second main theme, Communication, included Self-Expression, Exchanging Information and Learning as subthemes. These bring to mind Yalom and Leszcz’s (2005) therapeutic factors of Catharsis, Imparting Information and Interpersonal Learning.

It is worth recalling here that the groups considered in the present evaluation were conducted with inpatients who were often socially isolated and cognitively impaired; an important aim of the groups was simply to improve communication among people for whom informal relationships and interpersonal communication were often severely challenging. Nativ (2014) pointed out that where ego failure has led psychotic patients to withdraw from external reality, communication with others can reduce the concomitant isolation, loneliness and sense of loss. The main theme Communication and its subthemes suggest that the aim of improved communication was successfully attained for several group members and that developing group-based interventions in our services had clinical validity.

The third main theme was Help and Support. The subthemes here, Receiving Help and Support, Emotional Support and Practical Issues, referred to practical help and advice, empathy and feelings of acceptance and safety in the groups. These overlap with the therapeutic factors Group Cohesiveness, Universality and Interpersonal Learning (Yalom and Leszcz, 2005).

Hope for the Future, the fourth main theme, evokes Yalom and Leszcz’s, (2005) Instillation of Hope, which was perceived as the most important therapeutic factor in Restek-Petrovic et al.’s (2014) study. In the present evaluation, this main theme comprised subthemes Hope and Future. These findings seem significant given that our group members were all inpatients in mental health wards, many with long histories of severe and enduring difficulties and repeated admissions to hospital. Some had difficulty attending the ward-based groups regularly or consistently. Their continuing hope for the future may have emerged from their participation in the groups and from the opportunities for enhanced communication and experiences of reciprocity in giving and receiving support provided by the groups.

The final main theme extracted from the data was Relationships. This included the subtheme Self in Relation to Others, which in turn comprised MIEs coded together as Feeling Understood. This once again points to the therapeutic potential of inpatient groups in enabling group members to develop relationships and feel understood—for some, perhaps, for the first time. This experience of resonance and reciprocity refers also to Yalom and Leszcz’s (2005) therapeutic factors of Universality and Group Cohesiveness.

Many psychological difficulties seem to reflect a fundamental need to belong, or a ‘ . . . frustration and purposelessness when one’s need to belong goes unmet’ (Baumeister and Leary, 1995: 521). Loat (2011) pointed out that factors such as discrimination and stigmatization often cause those suffering severe and enduring mental health difficulties to experience prolonged social isolation. Group-based interventions can counter this by providing opportunities to form relationships with others who share similar experiences (Loat, 2011).

Considered together, the main themes and subthemes described above appear to provide support for the group analytic proposition that ‘Healing and resolution can be found for suffering in the very association of those who are hurting’ (Schlapobersky, 2016: 6). Inpatient groups for people with severe and enduring mental health difficulties should therefore continue to be an important component of statutory mental health care.

The MIEQ has good clinical utility in that one simple question can be used to evaluate a diverse range of therapy groups. In the present evaluation, only four (of 192) responses could not be coded. This indicates that the MIEQ is a quick, user-friendly and meaningful way to elicit inpatients’ views about their experiences of attending groups—although interpreting and extracting meaning from the responses is a more protracted process. It is a useful tool for group analysts to use to evaluate groups in public services or the third sector—groups that they themselves facilitate or those they contribute to indirectly through their supervision of multidisciplinary colleagues and other health workers.

It is worth noting that the ethnicity of the group members included in this evaluation was not specified; MIEs were routinely collected as part of the evaluation of the groups, without regard to group members’ social or demographic characteristics. However, it is well-established that individuals from black and minority ethnic (BME) groups, particularly Black-African and Black-Caribbean groups, are over-represented in inpatient settings, both in the UK in general and in inner-city services (NIMHE, 2003; CQC, 2011). Previous research and surveys have indicated that ‘talking therapies’ are less likely to be offered to people from BME backgrounds than to white patients in mental health services in the UK (e.g. British Psychological Society, 2009). It would be helpful to establish whether that finding applies equally to group-based interventions in wards such as those included in the present evaluation. Group analysts conducting groups or contributing to groups-based mental health services in the NHS should aim whenever possible to guard against such imbalances.

It is also important to note that the present evaluation did not aim to assess whether or not the groups in our inpatient settings were effective in changing behaviour, improving functioning, or achieving any other such measurable outcomes. Hospital admissions include a range of interventions: therapeutic groups and activities not included in this evaluation, medication, one-to-one support, individual psychology or psychotherapy, and occupational therapy, as well as removal from the usual social environment. Any or all of these may be expected to contribute to overall outcomes for mental health inpatients.

Rather, this evaluation aimed to identify patterns in those events regarded as ‘important’ by participants in a particular set of groups facilitated or co-facilitated by the clinical psychologists / authors of this article. This not only provides valuable new information about the group members’ subjective experience of ward-based groups, it may also guide the way that inpatient groups might be focused in the future, and thereby improve group attendance and treatment adherence by this often difficult to engage patient group.

Groups conducted in inpatient settings need to allow for and manage patients’ ambivalence, lack of motivation and tendency to social withdrawal and isolation—all possibly manifestations of an ‘anti-group’ phenomenon (Nitsun, 1996). Anti-group phenomena may be present also in ward staff teams or sub-groups of the team (Nitsun, 1996): patients may be moved between wards or services, or be discharged with relatively little forward planning or notice for group facilitators. These factors may all have contributed to the irregular or inconsistent attendance at the groups included in this evaluation. This inconsistent attendance may well affect patients’ experience of the group-as-a-whole over time. However, the present evaluation was careful to assess Most Important Events at the end of each group session so that responses related only to those sessions in which group members had participated and were present when the session ended. Furthermore, group members were asked to reflect on and describe an individual experience— ‘what was the most important event for you . . .’ —within a shared group context— ‘ . . . in today’s group’. We believe that this methodology helped to locate the isolated individual’s experience within a social context, thereby enhancing their sense of feeling connected at the point at which they were about to return to the potentially less cohesive, more isolating environment of a larger group—the ward environment.

Conclusion

Inpatient mental health wards are often criticized for the limited provision of meaningful activity and engagement aimed at trying to meet individuals’ hitherto unmet needs (BPS, 2009). These systemic difficulties may be exacerbated by recently introduced arrangements for delivery of services in the NHS which are framed with the expectation that outcomes will be measured, targets met and budget reductions achieved. Cuts to the budgets of mental health services may result in shorter admissions, less chance for therapeutic engagement and intervention, and a higher frequency of ‘revolving door’ patients with repeated admissions, in both acute and rehabilitation inpatient wards. Group-based interventions may be more difficult, but potentially more therapeutically effective in ward environments which are subject to such constraints. It will therefore be even more important to ensure that groups continue to be offered to provide their members with experiences which are as meaningful to them as possible, and which have the potential to enhance communication and a sense of connectedness with others. Group analysts working in the NHS are well placed to lead and evaluate services of this kind, in order both to develop and support evidence-based practice, and to promote and encourage practice-based evidence.

Repeating the Most Important Event Questionnaire in each session of a group may serve to draw group members to reflect on what has been important in that session and, over time, in the whole group process. By asking the MIEQ question, group facilitators contribute to a conscious or unconscious sense of group cohesiveness. The MIEQ can provide a sense of closure to the session, a sense of completion and cohesion which encourages group members to finish each session with an experience of the ‘group-as-a-whole’, with all group members looking at their own experience in the group, at others’ experiences, and at the experience of the group-as-a-whole.

This evaluation prompts questions about the definition of therapeutic factors in groups with people with severe and enduring mental health difficulties. Our findings suggest that there may be more fundamental levels of therapeutic factors to be explored—factors which reflect something of what it means for people with severely disturbed or disrupted attachments to feel connected to others, to be able to communicate some of their feelings, fears and concerns to others, and to experience a sense of belonging somewhere in the world.

Footnotes

Notes

Kenneth Bledin is a clinical psychologist and group analyst in private practice. He is a full member of the IGA (London), and was formerly head of Rehabilitation and Recovery Psychology, Camden and Islington NHS Foundation Trust. Address: c/o The Manor House Centre for Psychotherapy and Counselling, 80 East End Road, London N3 2SY, UK. Email: kdbccp@aol.com

Maddy Loat is a clinical psychologist specializing in psychotherapy and an honorary group analyst. She currently works in the NHS and in the third sector. Address: c/o Camden and Islington Psychodynamic Psychotherapy Service, Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK. Email: maddy.loat@icloud.com

Anna Caffrey is a clinical psychologist in Adult Mental Health with Central and North West London NHS Foundation Trust. Address: Department of Psychology and Psychotherapy, 1 Nightingale Place, London SW10 9NG, UK. Email: annacaffrey@nhs.net

Kathy Bonshor Evans is a clinical psychologist in Mental Health Rehabilitation, Lead Psychologist for North Kensington CMHT and Honorary Clinical Teacher at UCL Department of Clinical, Educational and Health Psychology. Address: Psychology Department, Pall Mall Mental Health Centre, 150 Barlby Road, London W10 6BS, UK. Email: kathy.bonshorevans@nhs.net

Bethany Taylor is a clinical psychologist in Mental Health Rehabilitation services in Camden and Islington NHS Foundation Trust. Address: Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK. Email: bethany.taylor@candi.nhs.uk

Morris Nitsun is consultant psychologist in Group Psychotherapy, Camden and Islington NHS Foundation Trust, and group analyst, the Fitzrovia Group Analytic Practice. Address: Fitzrovia Group Analytic Practice, 51 Warren Street, London W1T 5JH, UK. Email: mnitsun@blueyonder.co.uk

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‘Most Important Events’ and Therapeutic Factors: An Evaluation of Inpatient Groups for People with Severe and Enduring Mental Health Difficulties

Abstract

Keywords

Introduction

The ‘Most Important Event’

Problems with Measuring Outcome in Inpatient Groups: The Case for a Qualitative Methodology

Method

Group Members

Exclusion Criteria

Procedure

Analysis of Most Important Events (MIEs)

Results 1

1. Being Part of a Group

2. Communication

3. Help and Support

4. Hope for the Future

5. Relationships

Discussion

Conclusion

Footnotes

Notes

References

Results¹