A qualitative study of service user non‐engagement in psychological therapy groups on acute mental health wards

Abstract

AbstractAims and methodNon‐engagement with psychological therapy groups in mental health settings is a long‐standing problem, with implications on group processes and service delivery. Little is known about service user‐related factors hindering this engagement, especially on inpatient wards. We aimed to investigate the perspectives of service users on barriers to engagement with a therapeutic group facilitated by assistant psychologists. Experiences of therapy groups were explored via focus groups and in‐depth semi‐structured interviews with 16 participants on two acute wards. Data were analysed by means of thematic analysis adopting an inductive approach embedded in a constructivist paradigm.ResultsThe analysis identified three higher‐order themes: ways that facilitators might encourage group attendance; a need for safe therapeutic conditions within the groups; and a need for good applicability of group content to recovery outside of hospital. The results are discussed with reference to psychological approaches, group therapy research and trauma‐informed care.ConclusionFindings bear implications on clinical practice within inpatient mental health settings, specifically: (a) the need to approach service users individually to invite to groups and establish role expectancies; (b) supervision for facilitators focussing on difficult group dynamics and creating robust groups agreements to facilitate containment; (c) working with teams to ensure stable, protected physical spaces for groups on wards, in turn avoiding the re‐traumatising effects of disruption; (d) emphasising that participation does not require sharing difficult personal information, to prevent destabilisation and improve uptake of group offer; and (e) increasing focus on applicability of skills through consideration of potential obstacles to their real‐life application.