Group Therapy Approaches for Managing Mental Illness

Introduction: Mental Illness and the Challenge of Long-Term Management

Managing mental illness in such a way that realistic life expectations, self-identity, and long-term health and wellness are fostered is one of the most enduring problems associated with health care in society. Mental illness represents a significant health problem with long-standing personal and social implications for the individual, the family, and the community, as unresolved management issues can — and often do — create difficult and even destructive social situations for all (Pollio, North, Reid, Miletic & McClendon, 2006, p. 31; Accordino, Porter & Morse, 2001, p. 16).

Chronic mental illness has long been recognized as having an impact on an individual's sense of self (Bleuler, 1950; Freud, 1958; Kraepelin, 1904; Sullivan, 1940). Estroff (1981) writes that "the chronicity of mental illness involves more than just the persistent and recurrent nature of the illness; it also includes the relatively permanent shifting of expectations and definitions of self" (p. 223). Estroff (1989) further describes schizophrenia as an "I am illness — one that may overtake and redefine the identity of the person. Having schizophrenia results in a transformation of self as known inwardly, and of person or identity as known outwardly by others" (p. 189). Charmaz (1983) refers to the suffering of the chronically ill as loss of self. A more optimistic view allows that the self need not be permanently lost in chronic illness, but can be recovered or reconstructed (Czuchta & Johnson, 1998, p. 31).

The individual with a fractured sense of self is far more at risk for social difficulties than one with a solid sense of self. Self-identifying with the disease rather than as an individual with personal goals and life expectations is an essential process, and one that often cannot be achieved without social challenges. Social challenges encountered in a safe environment — such as well-directed and planned group therapy — provide a productive way to help patients resolve these issues and move toward more productive and fulfilling lives, in spite of a mental illness diagnosis.

One of the newer issues associated with the management of mental illness is the trend in health care toward a managed care context, where techniques and standards of care are assessed frequently to assist in the most effective manner, reducing costs and long-term burdens on individuals and systems of care. Mental illness has been left out of many managed care systems partly because many individuals and institutions do not feel compelled to tackle this difficult social issue, yet managed care is an essential and lasting context of care.

Managed care is here to stay, and social workers must rise to the challenge or cede leadership to others. Managed care has forced the profession to think more critically about how its members provide care and how they can deliver the best quality of services to the most people under increasing resource constraints. The practice wisdom gained through years of providing case management services to people with severe mental illness, combined with state-of-the-art efficacy information, is critical to the development of responsive, individualized, and cost-effective mental health services. The involvement of consumers as partners in the development of managed mental health care is also critical to its success. Social workers have a unique role and responsibility in ensuring that this vision of consumer involvement is realized (Shera, 1996, p. 196).

It is for these and many other reasons that best practices must be adopted for the long-term management of mental illness. Without such standards of care and ethical considerations, mental illness can — and has — become a significant drain on the community. One of the best practices of the past, with regard to management of mental illness, has been group therapy — yet only when conducted with care, consideration, appropriate planning, and contextual development by skilled therapists and group leaders.