Verbatim Patient Disclosure

The patient states: "I've left two messages for my daughter... she doesn't call me back. I'm not surprised... I was at a dinnerparty and the seat next to me remained empty ... no one likes me and it is always like that."

TH: Can you share with us why this means that no one likes you and why you generally feel that no one likes you?" PT: That's just how I feel. When I don't get a call back it means no one likes me-it's what I think.

Multiple questions and statements are then asked and given by other patients in the group. My focus is toward guiding the patient to understand that he, (in this case), has an overriding negative belief system and that changing negative thinking into more positive thoughts will facilitate the recovery process. Following are examples of the types of questions posed:

• Why do you say nobody likes you? Can you name people who do like you?

• Can you think of other reasons why the seat next to you was empty?

You Can Teach an Old Dog New Tricks!

• Could you have any other explanation as to why your daughter did not return your calls?

• Does your daughter ever do nice things for you?

• Do you ever miss returning a call?

• Your expectations of others are always very high... I think you set the bar so high so then you can be disappointed.

• You tend to set things up so you can be disappointed again . .. like a self-fulfilling prophecy of doom.

• Can you possibly reinterpret these events and say how you feel if you put a positive spin on these events?

Various group members become involved and share their own faulty cognitions and how they have worked at changing them. Some members recommend, through their past experiences, that changing a negative mind-set to a positive one can be accomplished through the use of exercises. The patient makes a list of negative thoughts on one side of the paper and then on the direct opposite side of the paper, the patient counters his or her arguments with positive responses. For example:

Negative Thought Positive Thought

Nobody ever likes me. Scott and Ellen like me.

No one ever calls me. Yesterday I got a call from Toby.

It is suggested that the patients begin this list in the group and then take it home as homework and work toward finding as many negative thoughts as possible and then find as many positive thoughts to counter these negative beliefs. By doing this, the group therapist can evaluate a number of areas in which the patient is "stuck" in his or her negative thought and belief system when he or she cannot find a positive response to the negative belief.

CONCLUSION

A geriatric group requires that the therapist be very flexible in conducting the group. Differences between supportive, insight-oriented, cognitive-behavioral and reminiscent intervention paradigms can create boundaries that are frequently blurred. Most patients in the group are socially isolated and interpersonally alienated, have limited in terpersonal skills, and may have other difficulties such as some memory decline, hearing and vision decline, and gait disturbances. Regressive feelings, related to dependency are seen in this type group and the group serves to help them feel connected and not isolated and alone. The group, which ultimately becomes the family in one's later life, helps the patient feel again connected and no longer alienated from the world at large.

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