一種用於老年人的團體治療方法有神奇的效果


  April 1, 2008 (奧蘭多) — 佛羅里達大型照護機構、邁阿密猶太年長者居家與住院心智服務負責人Mark Agronin醫師表示,對個人治療和/或心理藥物治療無反應的那些有行為異常的年長者,一種門診病患組織計畫所進行的團體治療可以有神奇的效果。
  
  在此間舉行的美國老年精神醫學會第21屆年會中,Agronin醫師形容他的中心正進行嶄新的計畫,且發表Frieda這名案例,此案例在其他治療失敗之後迅速治癒。
  
  Frieda是一名84歲的婦女,在西伯利亞流放之後存活,儘管給予治療,仍感到憂鬱和專注在自體的病痛;她相當聰明,且堅持她並無憂鬱,不過,她唯一的快樂似乎只有在生活輔助機構的唱詩班唱歌時。
  
  Agronin醫師表示,當Frieda又再度讓他們治療師感到無力時,機會來了;他們開始這個嶄新的計畫,每天有架構的為其他治療方法無效的心智異常精神病患進行6至8週的進行治療計畫,這些病患病情穩定且可以參與團體討論。
  
  Agronin醫師表示,該計畫包括每天2次50分鐘的背對背團體治療,中間有10分鐘的休息。
  
  他表示,我試著說服Frieda 加入此團體,這花了一點功夫;該團體的領導人-有點像啦啦隊長、又有點像教育班長-第一週必須加入協助送Frieda來參加計畫,但是在第2週,事情開始改變;Agronin醫師表示,團體的成員都喜愛Frieda,因為她挑戰我們給她的所有標籤 —年老、沮喪、緊張;其他成員圍繞在她身邊,Frieda就像明星,她笑了、她的穿著比較明亮了,且她變得比較早出席。
  
  Agronin醫師表示,在接著1週的某一天發生戲劇性的改變,Frieda 打斷了有關憂鬱和焦慮的談話,表示:不要再聊這些了,我們來唱歌,她抓住兩側2位婦女的手,並且開始大聲唱Hava Nagila這首歌,這首歌的意思是「讓我們一起高興」;幾秒鐘之後,一群婦女圍繞著她,每個人舉高手臂、滿臉愉悅的一起唱歌;歌唱結束之後,Frieda感謝每個人並且大步跨出圈外。
  
  他表示,那是她來這團體的最後一天,但在往後的一個月,她有了些許改變,她比較熱衷參與活動且看比來比較快樂、有更多內涵。
  
  Agronin醫師表示,我了解我們藉由該團體完成了其他方式無法完成的任務;Frieda融入此團體且感到關愛與關心,並且獲得正面注意力,且不再憂鬱,而是滿懷關心的人。
  
  他觀察發現,有時候在團體中會有很戲劇性的事情發生,這在個人治療和藥物是很難發生的。
  
  【一個利他的機會】
  Agronin醫師表示,為老年人進行團體治療和為年輕人進行團體治療相比是種挑戰;舉例來說,團體中出現和討論的題材,必須將大部分年長者體力和心智比較弱的情形納入考量,場地必須適合輪椅進出,參加者也許需要交通接駁,團體治療時的休息時間也是重要的,因為老年人更需要補充水分和營養。
  
  不過,為老年人進行團體治療可以提供許多比個人治療更優的好處,這些包括與同儕進行結構式社交的機會、與其他人分享年紀相關的問題、付出與回收正向回饋的機會;他表示,這也給每個人一個利他的機會— 將他們自己奉獻給其他人 — 我想這是所有改變的其中一項。
  
  他指出,團體治療利用此架構,以心理教育方式提供舒適的無威脅的環境,提供實用的資訊與策略,計畫也為輕微認知缺損者和冷淡者設計心理刺激運動,這兩種類型的病患也是老年人常有的。
  
  美國老年精神醫學會第21屆年會:老年精神病跨文化創新研討。2008年3月15日。

Group Therapy for the Elderly<

By Marlene Busko
Medscape Medical News

April 1, 2008 (Orlando) — For elderly individuals with behavioral health disorders who are not responding to treatments such as individual therapy and/or psychopharmacological therapy, a structured outpatient program of group therapy can "work magic," said Mark Agronin, MD, director of mental health services at the Miami Jewish Home & Hospital for the Aged, Florida's largest long-term care facility.

In a talk here at the American Association for Geriatric Psychiatry 21st Annual Meeting, Dr. Agronin described his center's "New Beginnings" program and presented the case of Frieda, who went from treatment failure to rapid healing.

Frieda was an 84-year-old woman who had survived exile in Siberia and who remained depressed and preoccupied with somatic ailments despite treatment. She was highly intelligent and insisted that she was not depressed, although her only joy seemed to be singing in the choir in her assisted-living facility.

At a time when Frieda had "worn out" her latest therapist, an opportunity presented, said Dr. Agronin. The clinic had just started the "New Beginnings" program, a daily, structured, 6- to 8-week group therapy program for patients with psychiatric disorders such as mood disorders who showed a lack of improvement with other modalities but who were medically stable and able to participate in group discussions.

The program comprises 2 daily 50-minute back-to-back group therapy sessions separated by a 10-minute refreshment break, said Dr. Agronin.

"I tried to convince Frieda to come into the group, and it took a while," he said. The group leader, "part cheerleader, part drill sergeant," had to go in and help Frieda dress to get her to the program the first week, but in the second week, things began to change. "The group members loved Frieda, because she challenged all the labels that we gave them — being older, being depressed, being nervous," said Dr. Agronin. The others rallied around her, and Frieda "was a star." She was smiling, her clothes were brighter, and she showed up early.

Dr. Agronin described a dramatic incident that happened 1 day in the following week. Frieda interrupted a discussion about depression and anxiety by saying: "Enough talk about this. Let's sing." She grabbed the hands of the 2 women on either side and began belting out the song "Hava Nagila," which literally means "let's rejoice." Within seconds, she was surrounded by a group of women, all with their arms raised, singing together with joy on their faces. The song ended, and Frieda thanked everyone and strode out of the group.

"That was the last day that she ever came to the group, but in the months thereafter, there was a change in her. She was more engaged in activities and seemed a lot happier, more content," he said.

"I realized that what we had accomplished in the group was something that we were not able to accomplish in any other setting. It came down to Frieda really feeling cared for and feeling loved in this group and getting positive attention not for being depressed but for being a caring, strong person," said Dr. Agronin.

"Sometimes things happen in a group in a very magical way that is very difficult to achieve in individual therapy and with medication," he observed.

A Chance to Be Altruistic

Doing group therapy with the elderly has challenges that make it very different from working with younger individuals, Dr. Agronin noted. For example, the material that is presented or discussed in the group has to take into account the fact that most elderly individuals have some physical and cognitive disabilities. The location needs to be able to accommodate wheelchairs. The participants might need help with transportation. A refreshment break during the group therapy session is important because of hydration and nutrition issues in the elderly.

Group therapy for older adults can, however, offer several distinct advantages over individual therapy. These include the opportunity for structured socialization with peers, sharing age-related problems with others, and a chance to give and receive feedback and positive reinforcement. "It also gives individuals an opportunity to be altruistic — to give of themselves to other people — and I think that is one of the most transforming aspects of it," he said.

Group therapy using this type of structured, psychoeducational approach provides a comfortable and nonthreatening environment and provides practical information and strategies. The program is also designed to provide mentally stimulating exercises for individuals with mild cognitive impairment and apathy, which are common in geriatric patients, he noted.

American Association for Geriatric Psychiatry. 21st Annual Meeting: Innovative Research in Cross-Cultural Geropsychiatry. Presented March 15, 2008.

    
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