After working in military adult outpatient settings for about four years, I was asked to cover the psychologist position on an inpatient psychiatric ward. This has been a rather dramatic change for me. In the outpatient clinics I had focused on providing psychotherapy mostly within the framework of cognitive behavioral techniques and evidence-based protocols. In my transition to this new inpatient role, I wondered how my outpatient therapy skills would translate to this very different and fast paced environment.
I have been in the inpatient psychologist role for about a month now. While the psychological services I now provide are delivered in vastly different formats, I have been pleasantly reminded of the core concepts underlying and spanning the services mental health professionals provide. Two of my main objectives as the inpatient psychologist involve consulting on therapeutic goals at patient’s treatment team meetings and leading the ward’s interaction psychotherapy groups.
The traditional outpatient weekly hour-long individual psychotherapy session is not present on our short-stay inpatient wardmodel. Individual treatment planning is conducted at the patient’s treatment team meetings after the patient has been triaged. There are several professionals and paraprofessionals that make up the treatment team including the patient’s attending and resident psychiatrists, psychologist, social worker, nurse, recreation therapist and mental health technician. At least once a week the team meets with the patient to discuss the treatment plan and progress. It is powerful to see the impact on mood when a patient trusts their team. Furthermore, the shift in a patient’s demeanor and focus once engaged in being a member of their own team seems to be a first step toward self-commitment to recovery. A patient’s motivation and willingness to actively participate in their own care is central to therapy at any stage.
The inpatient psychotherapy group also has a very different format than an outpatient group. The nature and variety of patient symptoms on an inpatient ward as well as the rapidly shifting population does not allow for a topic or diagnosis focused group that are popular in outpatient settings. Instead, traditional style processing groups are often chosen. Our ward has chosen to run an interaction group based on Dr. Irvin D. Yalom’s work for the higher-level patients on our unit. In leading these process groups, I have been reminded of the foundations of psychotherapy. Exploring difficulties in the context of a group of peers often allows for discussion of loneliness, relationship difficulties and discovery that others have experienced similar emotions related to life difficulties which decreases feelings of isolation.
Being on the inpatient ward has pulled me away from focus on evidence-based theory and concepts. This has allowed me to reconnect with and contemplate important basic proponents of treatment planning and psychotherapy, which are important factors at any level of care.
Yalom, I. D. (1983). Inpatient group psychotherapy.New York: Basic Books.
Yalom I. D. (1985). The theory and practice of group psychotherapy. 3rd Ed. New York: Basic Books.