Identifying Recovery Themes in a Short Term Inpatient Group for Persons with Schizophrenia

Background and Purpose:

Introducing evidence- based recovery-oriented groups during an inpatient stay for persons with schizophrenia is uniquely challenging given increasingly short hospitalizations and rotating group membership.  Using standardized process recordings as field summaries, we report on a qualitative content analysis of an evidence informed wellness psychoeducation group conducted by supervised social work interns in a state psychiatric facility over the course of three years.  Subjects included 87 group participants who attended an average of three group sessions each during their inpatient tenure.  Interns 15 curriculum-driven topics in rotation that included both illness-related (e.g. medication management;  shared decision making; care-receiving) and wellness-related (self-esteem; organization; humor) topics.  Our overarching research question was: Can persons hospitalized for a psychiatric crisis both process and apply concepts that build meaning and promote quality of life in the face of everyday symptoms and stressors?

Methods:

We used content  analysis to analyze the field summaries, which were prepared by an intern observer in rotation with group co-facilitators. Our research team included two senior clinician/researchers and two second year MSW interns who had not facilitated the groups.  Initially we individually coded 10 randomly selected documents from a total of 70 field summaries. We then hashed out areas of agreement and disagreement together, culminating in a set of individual codes that we organized by theme.  We each hand coded 15 additional summaries to further identify comments and exchanges that characterized responses among group participants and across sessions, using session topics as an overarching framework.

Results:

We identified six main themes that reflect a recovery-oriented sensibility during  an inpatient stay and that include both factors that facilitate and hinder efforts to remain well.   These included 1) awareness of being stuck, 2) impact on self of both internalized and external stigma, 3) struggles with managing symptoms, 4) wish for increased personal agency and advocacy skills, 5) ability to preserve hope and 6) openness to change. The themes are consistent with emerging literature and research on recovery among those with psychosis as defined by both mental health professionals and peer advocates.

Conclusions and Implications:

Our findings counter the general assumption that individuals hospitalized for a psychotic episode are unable to reflect on their lives and values and lack insight or awareness of their illness and circumstances.  The findings support emerging literature on recovery and potential among those with psychotic disorders, offering powerful examples of the ability to redefine self in the face of illness, connect with family and community, self-advocacy and shared decision making. Implications for practice and policy emphasize the potential for short term groups for those deemed so psychotic that they require hospitalization, and for strategies for successful training, replication, dissemination and implementation. Implications for research stress the need for 1) additional qualitative work in which group sessions are audio recorded to fully capture innuendo and exchange, and 2) a randomized controlled trial that evaluates the impact of such short term inpatient groups on wellness, personal agency, recovery and community tenure both at hospital discharge and over time.